BUTIMBA: Intensifying the Hunt for Child TB in Swaziland through Household Contact Tracing

PLoS One. 2017 Jan 20;12(1):e0169769. doi: 10.1371/journal.pone.0169769. eCollection 2017.


Background: Limited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB.

Methods: In partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications.

Results: From March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24-42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) were diagnosed resulting in a program yield of 1.6% for all forms of TB. The number needed to screen (NNS) to identify a bacteriologically confirmed TB case or all forms TB case traced from a child IC <5 years was respectively 62% and 40% greater than the NNS for tracing from an adult IC. In year one, we demonstrated a 32% increase in detection of bacteriologically confirmed child TB. Contacts were more likely to have TB if <5 years (OR = 2.0), HIV-infected (OR = 4.9), reporting ≥1 TB symptoms (OR = 7.7), and sharing a bed (OR = 1.7) or home (OR = 1.4) with the IC. There was a 1.4 fold increased chance of detecting a TB case in households known to be HIV-affected.

Conclusion: Contact tracing prioritizing children is not only feasible in a TB/HIV high-burden setting but contributes to overall case detection. Our findings support WHO guidelines prioritizing contact tracing among children and HIV-infected populations while highlighting potential to integrate TB and HIV case finding.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Contact Tracing / methods*
  • Eswatini / epidemiology
  • Family Characteristics*
  • Female
  • Humans
  • Male
  • Tuberculosis, Pulmonary / epidemiology*

Grants and funding

This project was supported by the TB REACH Initiative of the Stop TB Partnership (through a grant from Global Affairs Canada). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The primary grant recipient was the Baylor College of Medicine's Children's Foundation Swaziland (Program Director PAU). Mott MacDonald was contracted by the Stop TB Partnership to provide independent monitoring and evaluation of TB REACH projects. It contributed professional services and opinion independently of the funder (principally Global Affairs Canada), Stop TB Partnership and the grantee.